A free measles vaccine clinic Nov. 2, 2018, in Monsey, New York, posted signs for those taking advantage of the shots to tell staff about symptoms of any illness because they could infect others.(Photo: Rochel Leah Goldblatt, The (Westchester/Rockland county, N.Y.) Journal News)

Rockland County’s measles outbreak continues to develop, but federal, state and county health experts are taking every measure to turn the tide.

As of Monday, there were 47 confirmed cases of measles in Rockland, and 10 cases under investigation, according to Rockland Health Commissioner Dr. Patricia Ruppert. There have been hospitalizations, she said, including a patient treated in the pediatric intensive care unit. Measles cases are mostly in the Orthodox and Hasidic community, Ruppert said. Communities impacted include New Square, Monsey, Spring Valley, Suffern and New City.

New York State Health Commissioner Howard Zucker said he's been in Rockland twice in the last two weeks, along with officials from the U.S. Centers for Disease Control and Prevention. "We met with 45 rabbis and then 55 rabbis," he said of the two meetings at Refuah Health Center in New Square, a clinic that's worked closely with the Rockland County Department of Health on vaccination clinics amid the growing number of measles cases.

"We met with a women's group at Refuah," said the state's top doc, as well as school leaders, and community doctors and nurses.

Zucker said he and Ruppert were given an "excellent reception," and spent as much time as needed addressing concerns about the outbreak, and about vaccinations. Ruppert said that every rabbi she's talked to has assured cooperation and agreed that vaccinations are supported in Jewish law.

But the outbreak continues. So do the preventive measures.

The Rockland Health Department is offering free vaccines for anyone over 6 months old (MMR vaccines are usually first given at age 18 months). The department has banned unvaccinated students from attending yeshivas in New Square or any school in Spring Valley and Monsey where the vaccination rate is 70 percent or below.

The county's overall vaccination compliance rate is 94 percent, with New York state at 98 percent. The World Health Organization sets a 95-percent thresholdin vaccination rates to ensure so-called "herd immunity," which stops cases from spreading.

After holding several clinics in the New Square, Monsey and Spring Valley area, the county scheduled a clinic Monday, Nov. 5, from 3-5 p.m. at the county's health complex in Pomona.

People think this is just an issue within the Hasidic community. It's not.

"We have a small county, geographically," Ruppert said. "I've been saying all along that everyone should look at their vaccination records."

Vaccination rates vary

There's a wide variety of vaccination rates within the Orthodox and Hasidic comunity. More than 100 yeshivas are located in Ramapo alone, some serving just a handful of students and some with hundreds enrolled.

According to a state database, many Monsey-area yeshivas have vaccination compliance rates between just 44 percent and 80 percent. Still, of the 15 schools in Rockland that have 100 percent compliance, five are private Jewish schools.

But four secular private schools in Rockland fall into the 40-80 percent range. A public elementary school in Rockland has a vaccination rate under 85 percent.

Rockland's measles outbreak, and cases in New York City, Bergen County and Lakewood, New Jersey, have been linked to Israel. An 18-month-old died from complications of measles on Nov. 1 in Jerusalem. She was not vaccinated, according to the Jerusalem Post. Meanwhile, an outbreak in Europe has left more than three dozen dead.

"There's a component ... that are not in favor of vaccines," Zucker said. "We need to dispel any worries that they have."

Challenges

General skepticism about vaccinations, including the MMR shots, continues among some, no matter what community.

This questioning of vaccines plays out in different ways, though. Some swear off all vaccines, believing they carry more risks than the diseases they are designed to fight.

Other parents remained concerned about what they see as an overwhelming and aggressive vaccination schedule. They may want to slow the amount of shots given or skip certain inoculations. In a vacuum, they may opt out of vaccinations because they don't think their ideas will be welcome.

Ruppert said she's been talking with families who are "in between," who focus on delaying a vaccination schedule. They are amenable to education and explanation, she said, if their concerns are respectfully addressed.

In the current Rockland outbreak, Ruppert has said that none of the infected people were "fully vaccinated." Oneshot gives 93 percent immunity, Ruppert said, and acknowledged a few who had come down with the measles in Rockland had received one shot.

Zucker, who is a pediatrician with a subspecialty in critical care, said people aren't familiar with such diseases anymore, a success of public health. "I've seen these diseases, all of them, diptheria to measles," he tells them. "I've seen the measles encephalitis, I've seen whooping cough. I don't think any parent would want to experience that with a child.

"I recognize the worries of this," Zucker said of parents' concerns, "but I recognize the need for vaccinations."

Public health success, Ruppert said, feeds into resistance. "Most people do not realize what is done for them in preventative efforts in public health, because they never see what could have happened," she said. Because we prevent things, they don't see those diseases.

"That is a wonderful outcome," she said. The fallout from success, though? "We may not get cooperation in cases, or (needed) funding."

More come in

A clinic Friday in Monsey drew 99 people. One child was turned away, Ruppert said, because he showed symptoms of measles. Every person is triaged at the door, she explained, so any person infected doesn't end up spreading the virus at the clinic. "If they're looking sick, they don't come in the building."

Ruppert said she was gratified that the parents of the sick child decided to have the siblings receive the vaccine anyway.

Ruppert said it's hard to gauge why more are turning out for the clinics. She noted that the county's restrictions for attending school have clearly made an impact, as parents ask for notes so their kids can return. She also said that the death of a young child in Israel likely had impact.

"When they hear of a pediatric death, you see them come in," Ruppert said. "I don't want it to be only out of fear, I'd rather it be from education efforts."

A visit to one Orangetown pediatrician's office on Friday morning demonstrated the concern among Rockland parents and medical providers. A shipment arrived of extra MMR vaccines as the staff handled several phone calls from parents within a 10-minute period. Questions ranged from whether they should step up their kids' vaccination schedule to whether medical providers could promise their kid would be more at risk from the measles than from the vaccine itself.

Symptoms and schedules

Measles is a highly contagious respiratory disease — the germ coughed or sneezed out by an infected person can linger in the air for up to two hours. Symptoms include a fever, rash, cough, conjunctivitis and/or runny nose. It is contagious from four days before to four days after the rash shows up. Symptoms may not appear for a week to three weeks after exposure.

Complications include pneumonia, brain damage, deafness, and death. Measles can be dangerous, especially for babies, young children and pregnant women who haven't had the virus. Some people with immune system problems cannot be vaccinated; they rely on that "herd immunity" to protect them.

Usually, the MMR shot is given twice — once between ages 1 and 3 and then again around age 4, before entering school.

New York requires measles immunization to enroll in schools, daycare, and pre-kindergarten, although religious and health exemptions can be granted.